Healthcare Provider Details

I. General information

NPI: 1639721186
Provider Name (Legal Business Name): ALL DIMENSIONS PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 ALLEN STREET
RUTLAND VT
05701
US

IV. Provider business mailing address

92 ALLEN STREET
RUTLAND VT
05701
US

V. Phone/Fax

Practice location:
  • Phone: 802-776-4045
  • Fax: 802-773-7022
Mailing address:
  • Phone: 802-776-4045
  • Fax: 802-773-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: PATTY A THORNTON
Title or Position: OWNER
Credential: PA-C
Phone: 802-776-4045